Tag Archives: £670 million

After what seems like an eternity, the adult social care funding White Paper will finally be published tomorrow. So what will be in it? Here is my bit of crystal ball gazing…

Firstly, it will lay out Labour’s plans for a National Care Service that provides clear national entitlements for everyone, rather than the current postcode lottery. This was first mentioned in last year’s green paper and the idea at least was widely welcomed. The White Paper should flesh out exactly what that might entail and the funding for it.

The free personal care at home policy will also be in there. This has been championed by Gordon Brown and there isn’t a chance it will be dropped now, although the timing of its introduction may be put back until after the election.

In terms of funding, I expect that a ‘partnership’ model – where the state pays a portion of care costs and the service user pays the remainder – will be proposed. In the debate over funding, this seems to have garnered the most support and is something of a ‘middle’ way – and less politically divisive than, say, putting a levy on the estate of every person.

That option is a non-starter because the Conservatives branded it the “Death Tax”. Leaving aside whether it is a good idea or not, the negative publicity already around it would make implementing it political suicide.

Funding will probably be the most controversial part of this; while it is widely accepted that the current adult social care system needs to change, funding it is the tricky bit. For instance, the free personal care at home policy has been consistently lambasted because nobody believes the government’s estimate that it will cost £670 million – some say it could be more than £1 billion.

In addition, setting up a National Care Service, and contributing to everyone’s care costs, will cost billions. In a time where government departments – including the Department of Health – are scrabbling around trying to save billions, you wonder where the money would come from.

And then there is the election. The white paper will probably become a large spoke of the election campaign, which will be a bad thing. As I’ve mentioned previously, cross-party consensus is needed if the best solution for the public is to be reached. With an election, and all the ‘our policies good, your policies bad’ mudslinging that comes with it, this is out of the question.

Of course, the election also means that the White Paper may come to nought if Labour is ousted from power. The Tories have suggested they may go for another consultation before they do anything. If there is a hung parliament, who knows what will happen to it?

So, with that in mind, tomorrow’s White Paper may make promises, but it is by no means certain that essential reform will come to the sector just yet.

As the Free Personal Care at Home Bill creeps its way through Parliament, the voices against it get louder – but yet they still seem not to be heard.

Lord Warner, a former health minister, attempted to get the Bill delayed in a motion to the House of Lords, but lost the vote yesterday.

He said that the government should wait to implement the Bill until it knows what it is doing with the wider review of care funding. That should be in the much-vaunted White Paper, although time is running out for it to be published this side of the election.

Like many others in the sector, Lord Warner also believes the government has got its sums wrong with the policy. For example, ADASS reckons that it could cost local government £500 million, double what is estimated – and pushing the total cost close to £1 billion. If they are right, it could impact on other care services, especially those for people with lower levels of need, as local authorities scramble to find the funds.

The government dismisses these criticisms, saying that the scheme has been properly costed.

Moreover, the Bill still doesn’t address some of the major issues in care and care funding. The plan does not mean that more people will be able to access care services, just that more – that all-important middle class, say cynics with an eye on the election – will be able to access them for free.

Also, it doesn’t address people having to sell their homes to pay for residential care; while they may get free care at home, as soon as they move out they will have to pay.

Of course, as I mentioned earlier, this is only part of the government’s plan for adult social care funding. However, when their full plans are revealed – and those of the Conservatives and Liberal Democrats – I suspect that how they will be funded will be the primary talking point.

In an ideal world, the details of how people will be cared for should be paramount. While it will still be very important – obviously – I suspect that money (or lack of it) will talk the loudest when it comes to choosing new policies. Whether that means we get the best solution for service users is another matter.

Ever since Gordon Brown announced plans to give free personal care to the elderly late last year, the policy has faced a sustained barrage of criticism. And it isn’t showing any signs of stopping.

While in theory, free personal care for the elderly in their own home sounds like a great idea, the practicalities of it could well outweigh the benefits, according to leading figures in social care.

One of the major bugbears is the cost. The government reckons it’ll cost £670 million, but nobody else seems to; the vast majority of commentators think they have significantly underestimated.

Where the money will come from is another bone of contention. There is no new government money for this, it will come from a variety of sources; the majority, £420 million, will come from existing Department of Health budgets, while local authorities will provide the remaining £250 million from ‘efficiency savings.’

‘Efficiency savings’ is a woolly phrase at the best of times, but it is particularly worrying for council leaders because they are already trying to find millions of savings in anticipation of swingeing budget cuts in 2011.

Now some, including the heads of Hampshire and Essex councils, are publicly warning that to pay for the policy could mean council tax rises of a couple percent – never popular among the public, even less so when there is a recession on – or cuts to frontline services.

But the objections are not solely for financial reasons. A senior figure within social care told me that the policy could create perverse incentives for people to not go into residential care; if they went into a care home, if they have assets worth in excess of £23,000 they would have to pay for their place, whereas in their own home, care is free.

As a result, older people could stay in their own home for longer than it is really safe for them to do so, and could also become isolated, if they are housebound. Is that really a better option than residential care, where they have round-the-clock care, plus the company of the staff and other residents?

However, this unpopular policy may never make it into force. Lord Lipsey, a Labour peer – and vocal critic of the bill – believes that it has no chance of coming into force before the election. What happens after will depend on which party wins.

There is a feeling among some – including, perhaps inevitably, Conservative health spokesman Andrew Landsley – that the policy was announced to gain political capital.

If what its critics say will happen does, the bill could well end up backfiring on Labour, as well as the social care industry. For everyone’s sake, let’s hope they are wrong.

This will have set alarm bells ringing in Westminster this morning; Harriet Dempster, president of Scottish social work body the Association of Directors of Social Work, has admitted on radio that Scotland may not be able to afford its policy of free social care for all elderly people for much longer.

With costs for the policy rising – it was up 11% last year to £358 million – and swingeing budget cuts on the horizon, Ms Dempster said the policy may have to become means-tested.

Ms Dempster has called for a debate on the policy’s medium to long-term viability, including whether more well-off elderly people could afford to pay for services. In response, the Scottish Government has said it remains committed to the policy.

The Scottish experience should be heeded by ministers in England as they consider introducing a similar programme, as outlined in its Personal Care at Home Bill earlier this week. The government says that it “will cost £670 million per year”, but these have been widely questioned.

Indeed, the £358 million cost of the Scottish scheme is for only 50,000 people; the English version could cover up to 280,000 people with ‘substantial and critical’ needs. So if the costs were the same on both sides of the border – they won’t be, but this is just for example purposes – in England that could mean the policy costs about £2 billion per year. This figure doesn’t include the further 130,000 people who will help with ‘re-ablement’ in order to regain their independence and prevent ill health.

If – and it’s a big ‘if’ – the policy did come in, that £2 billion figure would quickly rise, simply because of demographics; the UK has an ageing population so more people would need it in time.

Again, with budget cuts coming, where would the money for this come from without making cuts to other services? Answers on a postcard please…

Another day, another political row about the government’s free social care at home for the elderly plan. Today, it’s how the plan is being funded.

While the government has been criticised for thus far being oblique about where the money will come from to fund the plan – they estimate it will cost £670 million per year, but others think it will be much higher – now they are starting to say where money will come from, they are garnering more criticism.

Health minister Andy Burnham, as reported in today’s Times on the eve of the publication of the Social Care Bill, says that “£60 million would be diverted from the health service’s research and development budget and £50 million from public health promotions.”

Inevitably, scientists have warned against cutting research budgets. The current research budget is more than £1 billion per year, so that cut is hardly a drop in the ocean.

Research is key for the future of healthcare and should be considered an investment – having drugs that cure is cheaper than the cost of lengthy treatment – and cuts should be avoided if possible.

However, the money will have to come from somewhere – if the Bill actually gets passed before the election, which is not guaranteed – and tough decisions will have to be made about which budgets get cut. It’s what we have government for; they make the hard decisions so we don’t have to.

It could be that funds are found from elsewhere. For example, a productivity drive in the NHS is expected to make up to £20 billion in efficiency savings in the next 4 years, which would more than pay for the Bill.

But wherever cuts come from to fund the free personal care plan, someone is going to be left unhappy. Well, almost; nobody has criticised the plan to save £60 million by cutting down on management consultants. Strange, that.

As the debate continues over the announcement in yesterday’s Queen’s Speech of plans for free personal care at home for those in most need, what it does highlight is a lack of political consensus over the future of social care.

Leaving aside the debates on whether the announcement was just electioneering or if the government’s got its sums right with the £670 million per year cost, the hammering it got from the other main political parties’ shows that all have different ideas about the future of social care.

Labour has pinned its hopes on a National Care Service, which yesterday’s announcement is a trailer for and has been covered in the recent green paper.

Meanwhile, the Conservatives have mostly criticised Labour’s plans, while their own proposals have been relatively thin on the ground. The main one has been the idea of the insurance scheme, where people would pay £8,000 and then get free personal care as and when they need it.

As for the Liberal Democrats, they have advocated greater integration of health and social care, and that care be provided on the basis of need rather than ability to pay, but nothing much else recently.

It is widely accepted that social care needs overhauling but surely on something as big as this, and that affects so many people, the parties should be working together on it.

After all, service users and social care professionals surely want to know that policies will be consistent and not changed every time a new government is elected – that can be as harmful as doing nothing.

Finding a way forward is difficult – the debates over the green paper demonstrate this – but this should surely rise above the usual politicking for the good of the millions of service users and carers out there. It should, but I doubt it will.

While the announcement of free personal domiciliary care for those with the greatest need was a central point of today’s Queen’s Speech, finding anyone with a positive outlook on it is difficult.

The combined weight of anti-government feeling and deep-rooted cynicism in the care sector means that the policy has been given a lukewarm response at best.

Critics cite a number of problems that haven’t been properly answered. For example, many question the costs involved; it is said to cost £670 million a year, but nobody seems to believe that. Also everyone wonders where the money for that is coming from – woolly references to ‘costs savings elsewhere in the NHS’ don’t cut it. Some also suspect councils will start to get tougher on what exactly constitutes ‘substantial and critical’ needs in a bid to save money.

It also doesn’t address the media’s perennial favourite topic of people having to sell their homes to pay for residential care. Health minister Andy Burnham admitted on Radio 5Live this morning that when someone needs to move into residential care, they will have to pay for that as they would within the current system.

It is, as Labour admits, an interim measure before the full adult social care white paper is published – but no-one quite knows when that will be, or indeed if it will get published.

The cynic in me wonders if this is just an early bit of electioneering, attempting to embarrass the Conservatives if they decided to ditch the policy, and painting Labour as a ‘caring’ party.

Indeed, whatever the pluses and minuses of this policy, it is still unlikely to make it onto the statute book before the election comes – there are only 70 working days left before the election and Tory peers have vowed to hold up legislation in the House of Lords, if it gets there.

While the idea is good – it could help 400,000 people – it does not solve the social care problem, and this seems to be one of the big criticisms. Social care needs a radical overhaul, and this only goes a relatively small part of the way. The next government – whichever party it is – needs to go much further.